Provider Demographics
NPI:1407421316
Name:HENRY, SHELBY LYNN (RBT)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:LYNN
Last Name:HENRY
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3655 HOWELL FERRY RD STE 400
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-3186
Mailing Address - Country:US
Mailing Address - Phone:770-373-5822
Mailing Address - Fax:248-712-4382
Practice Address - Street 1:3655 HOWELL FERRY RD STE 400
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-3186
Practice Address - Country:US
Practice Address - Phone:770-373-5822
Practice Address - Fax:248-712-4382
Is Sole Proprietor?:No
Enumeration Date:2021-05-24
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No156F00000XEye and Vision Services ProvidersTechnician/Technologist